Provider Demographics
NPI:1326146952
Name:G & V MEDICAL SERVICES
Entity Type:Organization
Organization Name:G & V MEDICAL SERVICES
Other - Org Name:HIGHLAND OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-923-8540
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1154
Mailing Address - Country:US
Mailing Address - Phone:219-923-8540
Mailing Address - Fax:219-923-6742
Practice Address - Street 1:8149 KENNEDY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1128
Practice Address - Country:US
Practice Address - Phone:219-923-8540
Practice Address - Fax:219-923-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042125A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000515082OtherBLUE CROSS BLUE SHIELD INDIANA
IN200868120AMedicaid
IL90001299OtherBLUE CROSS BLUE SHIELD ILLINOIS
INP00433671OtherMEDICARE RAILROAD
IL=========001OtherMEDICAID ILLINOIS
INP00433671OtherMEDICARE RAILROAD